Compared to X-ray, three-dimensional computed tomography measurement is a reproducible radiographic method for normal pr
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RESEARCH ARTICLE
Open Access
Compared to X-ray, three-dimensional computed tomography measurement is a reproducible radiographic method for normal proximal humerus Xiaoyang Jia, Yanxi Chen*, Minfei Qiang, Kun Zhang, Haobo Li, Yuchen Jiang and Yijie Zhang
Abstract Background: Accurate comprehension of the normal humeral morphology is crucial for anatomical reconstruction in shoulder arthroplasty. However, traditional morphological measurements for humerus were mainly based on cadaver and radiography. The purpose of this study was to provide a series of precise and repeatable parameters of the normal proximal humerus for arthroplasty, based on the three-dimensional (3-D) measurements. Methods: Radiographic and 3-D computed tomography (CT) measurements of the proximal humerus were performed in a sample of 120 consecutive adults. Sex differences, two image modalities differences, and correlations of the parameters were evaluated. Intra- and inter-observer reproducibility was evaluated using intraclass correlation coefficients (ICCs). Results: In the male group, all parameters except the neck-shaft angle of humerus, based on 3-D CT images, were greater than those in the female group (P < 0.05). All variables were significantly different between two image modalities (P < 0.05). In 3-D CT measurement, all parameters expect neck-shaft angle had correlation with each other (P < 0.001), particularly between two diameters of the humeral head (r = 0.907). All parameters in the 3-D CT measurement had excellent reproducibility (ICC range, 0.878 to 0.936) that was higher than those in the radiographs (ICC range, 0.741 to 0.858). Conclusions: The present study suggested that 3-D CT was more reproducible than plain radiography in the assessment of morphology of the normal proximal humerus. Therefore, this reproducible modality could be utilized in the preoperative planning. Our data could serve as an effective guideline for humeral component selection and improve the design of shoulder prosthesis. Keywords: Three-dimensional, Shoulder morphology, Shoulder geometry, Shoulder anatomy, Measurement, Computed tomography, Computer-assisted
Background Shoulder arthroplasty has been widely used for the treatment of glenohumeral osteoarthritis and severity fractures of the proximal humerus, which achieved positive clinical outcomes [1, 2]. It has been reported that restoration of the normal proximal humeral anatomy with prosthesis was very important for the postoperative clinical outcomes [1, 3]. To our knowledge, anatomic * Correspondence: [email protected] Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
reconstruction begins with accurate comprehension of the morphological characteristics of the normal humerus. Previous studies indicated that the morphology of the proximal humerus was considerably variable [4–10]. Meanwhile, a small mismatch between the natural humerus and prosthesis may lead to great changes in biomechanics [8, 11–14]. The normality of the
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